Effective 08/01/2022 Humana will be updating their preauthorization and notification lists for all commercial, Medicare and Medicare-Medicaid plans.

A review of the attachment is below but you can see the entire preauth and notification list at Humana.com/PAL

Commercial – Preauth is required for any inpatient admit prior to delivery.  Notification is required at time of delivery.  All maternity and newborn stays longer than the standard length of stay requires authorization.

Medicare – Procedure code 910 partial hospitalization.

Commercial and Medicare – Procedure code 93264 CardioMems

Humana Update to Pre-Auth and Notfication Lists

UPDATED LAUNCH DATE – JUNE 15, 2022!

Ambetter from Home State Health is pleased to announce an updated program launch date in its effort to address Missouri’s ongoing Opioid crisis.  It set to launch on June 15th, 2022. (The previous launch date had been set for January 1st).

For more information please visit our website at: Provider Resources Ambetter.HomeStateHealth.com

Articles in this issue:
● Beacon Endorsed Clinical Practice Guidelines
● Important Reminder
● COVID-19 Resources For Beacon Providers
● Measurement of Clinical Practice Guidelines
● Free Online Self-Management Tools for Members
● Reminder to Use Standardized Screening Tools
● Ensure Your Practice Supports Our Member Rights and Responsibilities
● Medical Necessity Criteria Available Online
● Reminders Regarding Beacon’s Ethical Approach to Utilization Management Decisions
● Appointment Access Reminder
● Cultural and Linguistic Needs of Beacon’s Membership
● Improving Care Coordination: An Essential Component of Client Care
● Referring to Beacon’s Care Management Program
● What is HEDIS?
● Why is HEDIS Important?
● What Behavioral Measures does HEDIS monitor?
● Behavioral HEDIS Measures

Beacon- April 2022 Updates and News

Topics include the following:

Behavioral Health

• Evernorth Behavioral Health Total Medical Cost initiative
• Evernorth Behavioral Health adopts LOCUS and CALOCUS criteria for level of care medical necessity review in California
• Evernorth Behavioral Centers of Excellence annual update
• SPRAVATO coverage change

COVID-19

• The latest updates

Pharmacy

• Drug list changes – SPRAVATO
• Drug list changes – Hyaluronic acid derivatives
• SafeGuardRx for Cigna expands its offering

General

• Gene Therapy Program Alert – CARVYKTI approved by the FDA

Government Programs

• Cigna Medicare Advantage – Post-acute care program expanded to include Arizona customers
• Cigna Medicare Advantage – CAHPS survey reminder

Administrative Policy

• Level of care management for certain ear, nose, and throat procedures
• Level of care management for certain general surgery procedures
• Reimbursement policy update – Facility supply codes

Cigna- April 2022 Updates

General News

• Telemedicine services eligible for billing
• PCR withholding, payments to be discontinued soon – Effective July 1, 2022
• Electronic prior authorization request option to be available soon on Medica.com

Clinical News

• Medical policies and clinical guidelines to be updated – Effective June 20, 2022

Pharmacy News

• Medica plans to update member formularies – Effective July 1, 2022
• Medica tentatively plans to update MHCP member drug list – Effective July 1, 2022
• Medica to add new UM policies for 2 new medical pharmacy Drugs – Effective June 1, 2022
• Upcoming changes to Medica Part D drug formularies – Effective May 1, 2022

Network News

• Medica to make quarterly update to Medicare fee schedules – Effective July 1, 2022
• Medica to make quarterly update to reference lab fee schedule – Effective July 1, 2022
• Medica to make update to MHCP physician fee schedule – Effective July 1, 2022
• Fourth-quarter PCR checks to be mailed in May 2022
• Temporary rate increase approved for PCA services
• Self Service Resources – Appeals and grievances e-learning

Administrative News

• Provider administrative training webinar for May
• Medica to update reimbursement policy – Effective July 1, 2022

Medica- May 2022 Updates and News

Upcoming webinars and the accompanying registration links are listed below. Registration is on a first come first serve basis. If you are unable to attend, the recorded webinars and related PowerPoint presentations will be posted here.

Clinical Webinars 

• Behavioral Health 101 – May 11 at 3 PM EST
• Integrating Harm Reduction Strategies Into Addiction Treatment Practice – May 12 at 1 PM EST
• Motivational Interviewing – May 12 at 3 PM EST
• Person-Centered Planning – May 25 at 3 PM EST
• InterQual for Providers – May 26 at 1 PM EST
•  Social Determinants of Health: Implications for Physical & Behavioral Healthcare – May 26 at 3 PM

Beacon Health Options Portals and Claims

• ProviderConnect Authorizations – May 4 at 2 PM
• eServices Overview – May 11 at 2 PM EST
• ProviderConnect Overview – May 18 at 2 PM EST
• Managed Care 101 – May 17  at 1 PM EST
• Claims Submission Guidelines – May 19 at 12 PM EST

Register in link below.

Beacon – Webinar Series for Providers and Office Staff May 2022

April Updates:

• COVID-19: Interim guidance for behavioral providers
  Learn more
• Frequently asked questions: EAP administration
  Learn more 
• Digital solutions: Video tutorials on self-service tools
  Learn more
• SPRAVATO® coverage change
  Effective July 1, 2022* Cigna will change how it covers SPRAVATO®. Learn more
• South Asian health disparities: Provider resources
  Learn more

Cigna Behavioral Health- Evernorth- Transformations Update April 2022

To align with the recent extension of the federal public health emergency (PHE) period, we are again extending the cost-share waiver for diagnostic COVID-19 testing and testing-related services through July 14, 2022 for individuals with Cigna commercial and Cigna Medicare Advantage benefit plans.

Other accommodations, including those related to credentialing and virtual care, also continue to remain in effect until further notice.

Cigna – Covid 19 Update- Public health emergency period extended through July 14, 2022

Administrative:

• Evaluation and management services for COVID testing[1]Professional
• 2022 provider manual is now available
• Resources to support diverse patients and communities
• Anthem announces changes to post-payment audits conducted on our behalf
• CAA: Timely updates help keep our provider directories current
• Primary care appointment access and open panels M
• May is National High Blood Pressure Education Month: We’ve got this!
• Alcohol use disorder has a big cost

Pharmacy:

• Specialty pharmacy updates – May 2022

Medical Policy & Clinical Guidelines:

• MCG Care Guidelines 26th Edition

Federal Employee Plan (FEP):

• CORRECTION: Save time tomorrow by using CPT II codes today: Introducing the FEP Quality Reimbursement Program for PPO providers
• Join us for an FEP Quality Learning Program live webinar

Medicare:

• Keep up with Medicare News – May 2022
• Convenient, reliable at-home testing for colorectal cancer and diabetes care
• HEDIS 2022: summary of changes from NCQA
• New specialty pharmacy medical step therapy requirements[1]March 2022 update

Anthem Provider Newsletter – Missouri May 2022